OBJECTIVE: The authors evaluate the safety, applicability, and effectiveness of a new technique for split-liver transplantation. SUMMARY BACKGROUND DATA: Split-liver transplantation offers an attractive way to increase the donor pool for cadaveric liver transplantation. The application of this concept has been hampered by inferior patient and graft survivals and higher complication rates. Without supportive data, the concern about increasing biliary leakage and poor initial graft function persisted. The authors focused on the causes of these complications by presenting a new technique to eliminate these problems. METHODS: Liver splitting was performed in the heart-beating cadaveric organ donor, using the technique described for procurement of the left lateral lobe of a live donor. A detailed description of the technique is presented. A retrospective review of the first 14 transplantations resulting from 7 in situ splitting procedures was collected. The results were compared with 19 conventional split-liver transplants performed during the same period. RESULTS: Six-month patient and graft survivals after in situ split-liver transplantation were 92.8% and 85.7%, respectively. Biliary complications were absent. Postoperative courses were mostly uneventful and characterized by lower peak transaminase levels compared with standard techniques. Early graft function of extrahepatic organs procured simultaneously was excellent. CONCLUSIONS: In situ split-liver transplantation provides superior results, related mainly to reduction of cold ischemic damage of the grafts and avoidance of biliary complications. In situ split-liver transplantation renders graft reduction alone obsolete and opens a donor pool for adults to receive right lobes safely. It allows for long-distance sharing between pediatric and adult liver transplant units because the procedure abolishes ex situ benching and prolonged ischemia time and provides two anatomically perfect grafts with hemostasis accomplished.
OBJECTIVE: The authors evaluate the safety, applicability, and effectiveness of a new technique for split-liver transplantation. SUMMARY BACKGROUND DATA: Split-liver transplantation offers an attractive way to increase the donor pool for cadaveric liver transplantation. The application of this concept has been hampered by inferior patient and graft survivals and higher complication rates. Without supportive data, the concern about increasing biliary leakage and poor initial graft function persisted. The authors focused on the causes of these complications by presenting a new technique to eliminate these problems. METHODS: Liver splitting was performed in the heart-beating cadaveric organ donor, using the technique described for procurement of the left lateral lobe of a live donor. A detailed description of the technique is presented. A retrospective review of the first 14 transplantations resulting from 7 in situ splitting procedures was collected. The results were compared with 19 conventional split-liver transplants performed during the same period. RESULTS: Six-month patient and graft survivals after in situ split-liver transplantation were 92.8% and 85.7%, respectively. Biliary complications were absent. Postoperative courses were mostly uneventful and characterized by lower peak transaminase levels compared with standard techniques. Early graft function of extrahepatic organs procured simultaneously was excellent. CONCLUSIONS: In situ split-liver transplantation provides superior results, related mainly to reduction of cold ischemic damage of the grafts and avoidance of biliary complications. In situ split-liver transplantation renders graft reduction alone obsolete and opens a donor pool for adults to receive right lobes safely. It allows for long-distance sharing between pediatric and adult liver transplant units because the procedure abolishes ex situ benching and prolonged ischemia time and provides two anatomically perfect grafts with hemostasis accomplished.
Authors: X Rogiers; M Malagó; K A Gawad; R Kuhlencordt; G Fröschle; E Sturm; M Sterneck; W Pothmann; J Schulte am Esch; M Burdelski; C Broelsch Journal: Transplantation Date: 1996-04-15 Impact factor: 4.939
Authors: X Rogiers; M Malago; N Habib; W T Knoefel; W Pothmann; M Burdelski; W H Meyer-Moldenhauer; C E Broelsch Journal: Transplantation Date: 1995-04-27 Impact factor: 4.939
Authors: K Urata; S Kawasaki; H Matsunami; Y Hashikura; T Ikegami; S Ishizone; Y Momose; A Komiyama; M Makuuchi Journal: Hepatology Date: 1995-05 Impact factor: 17.425
Authors: K Abu-Elmagd; J Fung; J Bueno; D Martin; J R Madariaga; G Mazariegos; G Bond; E Molmenti; R J Corry; T E Starzl; J Reyes Journal: Ann Surg Date: 2000-11 Impact factor: 12.969
Authors: Salvatore Gruttadauria; Fabrizio di Francesco; Duilio Pagano; Sergio Li Petri; Davide Cintorino; Marco Spada; Bruno Gridelli Journal: World J Gastrointest Surg Date: 2010-03-27
Authors: Andrea Lauterio; Stefano Di Sandro; Giacomo Concone; Riccardo De Carlis; Alessandro Giacomoni; Luciano De Carlis Journal: World J Gastroenterol Date: 2015-10-21 Impact factor: 5.742
Authors: Dieter C Broering; Christian Wilms; Christian Lenk; Jan Schulte am Esch; Silke Schönherr; Lars Mueller; Jong-Sun Kim; Knut Helmke; Martin Burdelski; Xavier Rogiers Journal: Ann Surg Date: 2005-12 Impact factor: 12.969